Health Outcomes

The AHS regularly links the cohort to State Vital Statistics and Cancer Registries to update mortality from all causes and cancer incidence. Other health endpoints are collected by self-report in periodic follow-up questionnaires. Specific health endpoints of interest are confirmed through additional participant contact, review of medical records, and, as required, clinical exam.

Table 2a: Applicator Post-enrollment (Incident only) Malignant Cancer Cases by Site and Data Collection Progress 1,2,3,4,5,6
Cancer Site Total with Cancer Completed Phase II QX
N=60,137		 Completed Phase III QX
N=44,129		 Completed Phase IV QX
N=42,331		 Completed Phase V QX
N=32,177		 Returned Buccal Sample
N=34,988		 Returned Dietary History QX
N=35,011
Bladder 565 496 368 390 240 328 314
Brain 88 72 47 45 19 44 44
Breast 85 76 60 61 44 38 38
Bronchus and Lung 857 739 457 435 157 405 395
Colon 669 568 399 395 233 343 311
Head and Neck 101 85 60 61 35 48 45
Kidney and Renal Pelvis 409 343 252 274 176 212 200
Leukemia 331 274 197 196 121 180 157
Liver and Intrahepatic Bile Ducts 85 79 50 49 28 39 42
Melanoma 592 507 383 411 296 302 285
Mesothelioma 20 17 15 12 4 11 10
Multiple Myeloma 175 155 99 94 55 96 91
NHL 833 716 513 541 354 506 426
Oral 236 207 155 148 101 125 127
Ovary 11 11 7 5 2 3 3
Pancreas 235 204 138 136 63 97 100
Prostate 3,755 3,201 2,546 2,538 1,848 2,306 1,852
Rectum and Rectosigmoid Junction 261 231 152 149 101 137 130
Stomach 114 103 68 57 31 63 61
Thyroid Gland 90 74 60 63 43 41 29
Uterine 13 13 9 9 6 5 4
Other 784 690 486 471 295 420 405
All 10,309 8,861 6,521 6,540 4,252 5,749 5,069

1 Cancer counts are based on complete registry data through 2022 for Iowa cases and through 2022 for North Carolina cases.

2 Subjects previously diagnosed with cancer at a different site are included.

3 Buccal cell receipts represent progress through 2014.

4 The 'Other' category includes in-situ bladder cancers.

5 SEER Site Recode ICD-O-3 (1/27/2003) Definition used for classifying cancers.

6 NHL is defined based on the SEER site recode.

Table 2b: Spouse Post-enrollment (Incident only) Malignant Cancer Cases by Site and Data Collection Progress 1,2,3,4,5,6
Cancer Site Total with Cancer Completed Phase II QX
N=60,137		 Completed Phase III QX
N=44,129		 Completed Phase IV QX
N=42,331		 Completed Phase V QX
N=32,177		 Returned Buccal Sample
N=34,988		 Returned Dietary History QX
N=35,011
Bladder 92 81 70 52 39 53 58
Brain 66 57 41 40 26 43 42
Breast 1,928 1,618 1,405 1,257 938 1,134 1,086
Bronchus and Lung 372 324 215 198 94 198 212
Colon 360 310 241 217 137 205 217
Head and Neck 11 8 5 6 3 5 4
Kidney and Renal Pelvis 133 108 100 83 61 68 68
Leukemia 114 94 83 70 39 59 56
Liver and Intrahepatic Bile Ducts 36 33 31 17 11 20 22
Melanoma 269 225 191 175 139 127 146
Mesothelioma 4 3 3 3 2 2 2
Multiple Myeloma 83 66 60 62 39 43 40
NHL 395 325 279 270 178 234 216
Oral 85 73 60 58 41 47 49
Ovary 148 121 96 94 48 76 79
Pancreas 129 101 85 75 34 57 60
Prostate 14 12 9 12 9 8 8
Rectum and Rectosigmoid Junction 97 81 70 61 40 54 56
Stomach 42 34 30 29 17 23 24
Thyroid Gland 152 132 104 91 78 85 83
Uterine 489 420 353 321 226 239 267
Other 418 360 281 246 156 210 240
All 5,437 4,586 3,812 3,437 2,355 2,990 3,035

1 Cancer counts are based on complete registry data through 2022 for Iowa cases and through 2022 for North Carolina cases.

2 Subjects previously diagnosed with cancer at a different site are included.

3 Buccal cell receipts represent progress through 2014.

4 The 'Other' category includes in-situ bladder cancers.

5 SEER Site Recode ICD-O-3 (1/27/2003) Definition used for classifying cancers.

6 NHL is defined based on the SEER site recode.

Table 3: Cause Specific Mortality of AHS Cohort, 1994-2021
Cause Frequency Percent Cumulative Frequency Cumulative Percent
Accidents 1,107 4.84 1,107 4.84
Cancer 6,584 28.79 7,691 33.63
Cerebrovascular Disease 1,181 5.16 8,872 38.79
Diabetes Mellitus 580 2.54 9,452 41.33
Heart Disease 6,098 26.66 15,550 67.99
Respiratory Disease 1,922 8.40 17,472 76.39
Other 5,399 23.61 22,871 100.00
Table 4: Medical Conditions asked about in Phase II 1
  Private Applicators
N=52,394		 Spouses
N=32,346		 Commercial Applicators
N=4,916		 Total
N=89,656
Completed Phase II Questionnaire 33,457 23,796 2,885 60,138
Cardiovascular Disease
Heart Attack (Myocardial Infarction) 1,789 370 122 2,281
Irregular Heart Beat (Arrhythmia) 3,267 2,571 243 6,081
High Blood Pressure or Hypertension 8,637 5,954 870 15,461
Endocrine Disorder
Diabetes or High Blood Sugar 2,429 1,314 188 3,931
Thyroid Disease or Thyroid Problems 1,075 2,947 90 4,112
Overactive Thyroid (Hyperthyroidism) 279 659 N/A 4 938
Graves Disease 62 151 N/A 4 213
Underactive Thyroid (Hypothyroidism) 528 1,792 55 2,375
Thyroiditis, Hashimoto's Disease, Autoimmune Disease 31 212 N/A 4 243
Enlarged Thyroid, Thyroid Nodules, Goiter 204 997 N/A 4 1,201
Other Thyroid Problem 113 169 N/A 4 282
Women's Health Disorder
Endometriosis N/A 2 1,694 N/A 2 1,694
Uterine Fibroids N/A 2 3,514 N/A 2 3,514
Benign Breast Disease (Fibroids, Cysts, Other) N/A 2 4,060 N/A 2 4,060
Pregnancy Induced High Blood Pressure,
Pre-Eclampsia, Toxemia or Eclampsia		 N/A 2 103 N/A 2 103
Gestational Diabetes N/A 2 77 N/A 2 77
Autoimmune/Musculoskeletal Disorders
Rheumotoid Arthritis N/A 2 908 N/A 2 908
Lupus (SLE) N/A 2 110 N/A 2 110
Sjogren's Disease N/A 2 43 N/A 2 43
Scleroderma or Systemic Sclerosis N/A 2 32 N/A 2 32
Kidney Disorder
Kidney Stones 3,862 1,279 200 5,341
Kidney Disease or Kidney Failure 354 214 28 596
Digestive Disorder
Inflammatory Bowel Disease
(Chron's Disease, Ulcerative Colitis)		 430 514 41 985
Skin Disorder
Vitiligo 130 84 N/A 4 214
Eczema 719 1,124 89 1,932
Psoriasis 821 582 76 1,479
Allergy to Bees, Wasps, or Other Insects 1,735 1,120 158 3,013
Optical or Hearing Disorder
Blindness 619 271 36 926
Nearsightedness 12,237 13,244 1,345 26,826
Farsightedness 13,683 11,673 1,217 26,573
Cataracts 3,427 2,965 199 6,591
Glaucoma 680 492 49 1,221
Detached Retina 358 179 30 567
Retinal or Macular Degeneration 391 368 34 793
Hearing Problems 11,781 N/A 3 913 12,694
Injury
Head Injury 6,623 1,556 726 8,905
Neck, Back, Spinal Cord Injury 6,250 2,198 588 9,036
Post-Polio Syndrome, Leg Injury 4,344 1,474 188 6,006
Neurologic Disorder
Epilepsy 123 127 N/A 4 250
Multiple Sclerosis 39 83 N/A 4 122
Parkinson's Disease 89 29 N/A 4 118
Tremor (Essential, Familial, Benign) 144 113 N/A 4 257

1 Numbers represent medical conditions reported during Phase II interviews. Because the asking of some questions was dependent on responses to earlier questions, the counts in this table reflect the numbers of each condition reported but not the total occurrence of the diseases in the cohort.

2 These conditions marked with N/A were not asked about in the men's health questions. Since 96 percent of private applicators and commercial applicators in the cohort are men, it would be misleading to report counts for these conditions in the private applicator column.

3 Hearing problems were not asked about in the women's health questions. Since 99.5 percent of spouses in the cohort are women, it would be misleading to report hearing problem counts in the spouse column.

4 These conditions occur in commercial applicators in insufficient numbers to be reported at this time.